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Sleeping through anxiety

How and why your anxiety might be keeping you up at night

April 10, 2017

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Having anxiety during the day is hard enough. But when it’s preventing you from going to sleep, it can be unbearable. And while anxiety may cause you to lose sleep, it can also make existing problems worse.

Luckily, there are ways to help. Dr. Richard Blackburn, a sleep psychologist who is certified in Behavioral Sleep Medicine, explains how anxiety impacts sleep and shares tips to manage it.

Why is it so hard to sleep when you have anxiety?

Let’s start with a little about how sleep works.

Sleep happens by balancing two forces that oppose each other. The first force is called sleep pressure. Basically, the longer you are up, the stronger this force becomes. If you are up for 16 hours, you’ll be tired. After 24 hours of being awake, sleep is more likely. And after 72 hours, it becomes difficult to stay awake.

The second force resists sleep pressure by pushing you awake. This force is an alerting signal that cycles based on an internal clock. It gets stronger as the day progresses and then is supposed to drop off at night. When this force drops in the evening, all the sleep pressure you built up during the day pushes you to sleep.

So how does anxiety affect this? The alerting signal force runs off many of the same neurochemicals anxiety uses. This is likely a great adaptive trait that aided our survival in the past. Imagine you were being chased by a pack of wolves. That would be a really bad time to go to sleep. Anytime you feel anxious, worried or threatened, the alerting signal gets stronger. It’s your brain’s way of saying, “If this is a threat, you should stay awake and deal with it.”

How can I tell if it’s anxiety or a sleep disorder?

Sleep disorders are very common in anxious people. Anxiety makes it difficult to quiet your mind and body to go to sleep. Not long ago, we believed that if the sleep problem was caused by another medical or mental health condition like anxiety, you would treat the cause and the sleep problem would go away. We now know this isn’t true. If the anxiety is treated, the sleep problem may remain. The current belief is that you must treat both problems.

But not all sleep problems start with another condition like anxiety. Some people only have anxiety about sleep. Their anxiety is caused about worrying about sleep or how they will function after a night of bad sleep. If this struggle continues night after night, they start to “dread the bed.” During the day, they aren’t anxious, but once they start thinking about going to bed, their anxiety rises. Other people are anxious about sleep because of something that happens during sleep. It could be nightmares, fear of sleep walking or other behaviors that only occur when the person is asleep and unaware, or waking up gasping for air due to untreated sleep apnea. Sometimes it’s fear of the dark. Additionally, about 40 percent of people who have panic attacks will have nocturnal panic attacks. Essentially, they wake up from sleep in a panic. All these things make sleep something to be feared, and if you dread your bed, you’ll have problems sleeping.

It basically comes down to the chicken and the egg problem: Did anxiety cause the problem with sleep, or is poor sleep the cause of the anxiety? If the anxiety caused the sleep problem, the person needs to treat both. If the anxiety is only about sleep, treating the sleep problem should be the first step.

What are the health risks of not getting enough sleep?

Short sleep and fragmented sleep are linked with increased risk of heart attack, stroke, obesity, accidents, memory problems, diabetes, difficulty with concentration and impaired learning. Sleep is sometimes referred to as the third pillar of health: Sleep, nutrition, and exercise. In order to be healthy, all three must be managed well.

What are a few tricks to help you sleep when you have anxiety?

Relaxation techniques help a person relax so that sleep pressure will be unopposed and they can fall asleep. Techniques such as breathing skills, progressive muscle relaxation, guided imagery, meditation, yoga, constructive worry, and mindfulness can all help. Right now, there are a lot of apps you can get for free that teach you how to do these skills. A favorite free app in the sleep community is called “CBT-i Coach.” It was made in partnership with Stanford University Sleep Center and the VA. It has a lot of useful information about improving sleep, including a section called “Quiet Your Mind.” All of the techniques that benefit anxiety and sleep are there, and your phone will guide you in how to use it.

Regions Sleep Health Center employs two sleep psychologists. Not only are they trained and experienced in clinical psychology and mental health treatments, but they have additional training in assessing and treating sleep disorders. If they determine that anxiety is your chief concern, they can help you connect with Behavioral Health to treat the anxiety and then offer treatment for insomnia. If the anxiety is strictly due to poor sleep, they can usually help improve your sleep without adding medications in six to eight weeks.

Here are some resources that can help with anxiety, sleep disorders and behavioral health:

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